NCPDP and CAQH CORE Partner on Harmonizing Operating Rules and Standards Across Healthcare

News provided by

Jun 15, 2011, 09:30 ET

SCOTTSDALE, Ariz. and WASHINGTON, June 15, 2011 /PRNewswire/ -- The National Council for Prescription Drug Programs (NCPDP) and CAQH CORE® (Committee on Operating Rules for Information Exchange®) today announced a partnership agreement to collaborate on activities related to harmonizing electronic data interchange standards and operating rules across the healthcare industry.

NCPDP and CAQH CORE began exploring the potential partnership in late 2010 when the National Committee on Vital and Health Statistics (NCVHS) recommended NCPDP be formally named as an operating rules entity for retail pharmacy-related eligibility transactions and CAQH CORE serve as the authoring entity for operating rules for non-retail pharmacy-related eligibility and claim status transactions. The NCVHS recommendations were made to the Department of Health and Human Services in response to the Patient Protection and Affordable Care Act administrative simplification requirements which mandate national operating rules. Recent recommendations by NCVHS for CAQH CORE to develop operating rules for electronic funds transfer (EFT) and electronic remittance advice (ERA) have furthered the collaborative efforts between CAQH CORE and NCPDP.

NCPDP President, Lee Ann Stember, stated, "Through standards development and harmonization, we will continue to break down healthcare information technology barriers and improve the cost and quality of care for the patient. We are pleased to collaborate with CAQH CORE on orchestrating operating rules and standards to improve the coordination and delivery of healthcare."

"CAQH CORE and NCPDP share a mutual commitment to industry collaboration and consensus building processes that focuses on actionable change," said Gwendolyn Lohse, deputy director and CORE managing director, CAQH. "Aligning our intersecting efforts will help advance widespread industry adoption of effective and productive healthcare exchanges."

Both organizations are foundational to the healthcare information exchange process: NCPDP, the ANSI-accredited standards development organization for pharmacy, has led the automation of pharmacy through standards development for over 30 years; and CORE, a multi-stakeholder initiative created by CAQH, develops and maintains operating rules to make administrative information available at the point of medical care.

About CAQH® and CORE®

A CAQH initiative, the Committee on Operating Rules for Information Exchange, CORE, has convened more than 120 healthcare industry stakeholders as participants in developing operating rules. A range of entities participate in CORE, including providers, hospitals, associations and states. Participating health plans cover more than 150 million lives, or approximately 75 percent of the commercially insured, plus Medicare and state-based Medicaid membership. Over 50 organizations are CORE-certified and driving adoption of the CORE operating rules. More information is available at www.caqh.org/benefits.php.

CAQH serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. CAQH solutions help promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange; and encourage administrative and clinical data integration. Visit www.caqh.org for more information.

About NCPDP

Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with over 1,600 members representing virtually every sector of the pharmacy services industry. Our diverse membership provides leadership and healthcare business solutions through education and standards, created using the consensus building process. NCPDP has been named in federal legislation, including HIPAA, MMA, and HITECH. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data services include the NCPDP Provider Identification Number, a unique identifier of over 75,000 pharmacies, and HCIdea, "The Prescriber Identity Solution." NCPDP's RxReconn™ is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity. For more information about NCPDP Standards, Data Services, Products, Educational Programs and Work Group meetings, go online at www.ncpdp.org or call (480) 477-1000.

SOURCE CAQH